Fine-scale spatial and temporal variation in temperature and arrhythmia episodes in the VA Normative Aging Study

ABSTRACT

Many studies have demonstrated that cold and hot temperatures are associated with increased deaths and hospitalization rates; new findings indicate also an association with more specific cardiac risk factors. Most of these existing studies have relied on few weather stations to characterize exposures; few have used residence-specific estimates of temperature, or examined the exposure-response function. We investigated the association of arrhythmia episodes with spatial and temporal variation in temperature. We also evaluated the association btween monitored ambient temperature (central) and the same outcome. This longitudinal analysis included 701 older men participating in the VA Normative Aging Study. Arrhythmia episodes were measured as ventricular ectopy (VE) (bigeminy, trigeminy, or couplets episodes) by 4-min electrocardiogram (ECG) monitoring in repeated visits during 2000–2010. The outcome was defined as having or not VE episodes during a study visit. We applied a mixed-effect logistic regression model with a random intercept for subject, controlling for seasonality, weekday, medication use, smoking, diabetes status, body mass index, and age. We also examined effect modification by personal characteristics, confounding by air pollution, and the exposure-response function. For 1°C increase in the same day residence-specific temperature, the odds of having VE episodes was 1.10 (95% confidence interval [CI]: 1.04–1.17). The odds associated with 1°C increase in central temperature was 1.05 (95% CI: 1.02–1.09). The exposure-response function was nonlinear for averages of temperature, presenting a J-shaped pattern, suggesting greater risk at lower and higher temperatures. Increased warm temperature and decreased cold temperature may increase the risk of ventricular arrhythmias.

Implications: This is the first study to provide evidence that residence-specific temperature exposure is associated with increased risk of ventricular arrhythmias in cohort of elderly subjects without known chronic medical conditions; that the delayed effect of temperature has a nonlinear relationship; and therefore that both warm and cold temperature increase the risk of having ventricular arrhythmias. Moreover, we show that the use of residence-specific temperature data reduces downward bias due to exposure error, by comparing the estimated health effect based on our spatiotemporal exposure prediction model to those based on a single local weather monitor.

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Funding

This work was supported by the National Institute of Aging, R21 AG040027-01, the National Institute of Environmental Health Sciences, P01 ES009825, P30 ES000002, R21 ES020194-01, and R21ES024012, and by the U.S. Environmental Protection Agency, RD-83241601 and RD-83479801. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the EPA. Further, the EPA does not endorse the purchase of any commercial products or services mentioned in the publication. This study was also supported by a VA Research Career Scientist award to David Sparrow. The Veterans Administration’s Normative Aging Study is supported by the Cooperative Studies Program/Epidemiology Research and Information Centers of the U.S. Department of Veterans Affairs and is a component of the Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.

Additional information

Funding

This work was supported by the National Institute of Aging, R21 AG040027-01, the National Institute of Environmental Health Sciences, P01 ES009825, P30 ES000002, R21 ES020194-01, and R21ES024012, and by the U.S. Environmental Protection Agency, RD-83241601 and RD-83479801. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the EPA. Further, the EPA does not endorse the purchase of any commercial products or services mentioned in the publication. This study was also supported by a VA Research Career Scientist award to David Sparrow. The Veterans Administration’s Normative Aging Study is supported by the Cooperative Studies Program/Epidemiology Research and Information Centers of the U.S. Department of Veterans Affairs and is a component of the Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.

Notes on contributors

Antonella Zanobetti

Antonella Zanobetti is a principal research scientist in the Exposure, Epidemiology and Risk program, in the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.

Brent A. Coull

Brent A. Coull is a professor of biostatistics and Associate Chair of the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.

Itai Kloog

Itai Kloog is a senior lecturer in the Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel. He is also a visiting scientist in the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.

David Sparrow

David Sparrow is a professor in the Department of Medicine, Boston University School of Medicine, and in the Department of Epidemiology at Boston University School of Public Health, and at VA Boston Healthcare System, Boston, MA.

Pantel S. Vokonas

Pantel S. Vokonas is a professor in the Department of Medicine, Boston University School of Medicine, and in the Department of Epidemiology at Boston University School of Public Health, and at VA Boston Healthcare System, Boston, MA.

Diane R. Gold

Diane R. Gold is a professor in the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA. She is a professor of medicine in the Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, and she is an associate physician at Brigham and Women’s Hospital, Boston, MA.

Joel Schwartz

Joel Schwartz is a professor in the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.